“Things we should change… Future Pathways for e-Health in NSW”: our response to the Patrick report and a resuscitation of EMR in Australia.

Claydata® are an Australian software development startup based in Sydney who are determined to revolutionise the way e-health is implemented. Already gaining a firm foothold in the US, where uptake of e-health is light-years ahead, Claydata® plan to provide the best electronic medical records (EMR) systems to Australian medical healthcare providers during a period in which Australia seems to be struggling to effectively navigate the wired world of e-health.

As has been pointed out in a number of informal online discussions about the failure of EMR implementations worldwide (for e.g. here and here), an important reason for such failure is the lack of communication between health IT deployment teams and the clinical staff they are there to support. Professor Jon Patrick, University of Sydney academic and co-author of the report on NSW’s failing e-health system, widely covered in the press, makes a number of recommendations in this regard. In the longer term, he suggests a review of Health Support Services (HSS) in NSW, including the appointment of a clinical head with an IT education. Moreover, he recommends a campaign to create a culture change in HSS that would encourage the voices of the clinical community to be heard.

Here at Claydata®, our lead product designer and many more involved in the development of the PuttyHealth™ EMR are practicing clinicians. The creation of Claydata®, a software development company with an e-health focus, was indeed inspired by the perception that there is a far from insignificant (and in light of NSW’s current predicament, a thoroughly dangerous) gap between existing EMR vendors and healthcare providers. This gap arises when a problem is not met by an adequate solution, an impasse that hinges on a lack of communication – of needs and desires – when it comes to articulating just what and how an EMR should work. We believe that our close relationship with the healthcare community goes far toward remediating this gap.

Patrick also hopes that his review will inspire the creation of pathways “for hospitals that wish to be early adopters and take a lead role in the development of new methods for using and deploying IT systems.” A stellar example is that of Macquarie University Hospital, here in Sydney. They have shifted to a healthcare delivery system that revolves around a rigorous e-health implementation, and they continue to innovate by being open to trials of new technology, such as the integration of tablet devices into their clinicians’ daily rounds.

We too are constantly seeking this horizon of innovation, and are pleased to have found our clients working productively with our system via an intuitive and secure iPad app in a number of healthcare contexts. We also understand the frustration involved in, one the one hand, adapting to a new system at all, and, on the other hand, finding that one cannot revert to tried-and-tested systems if the new is found to be lacking. The early stages of our e-health implementations are informed by these common obstacles and always proceed with staff support and systems redundancy in mind.

With our innovative EMR architecture, we also address what Patrick identifies as the ‘secrecy’ of healthcare information systems that has “bedeviled the efforts of staff and management to get improvements”. We think this is, for one, a corporate strategy that aims to jealously guard intellectual property, a deliberate opacity that frankly generates support service income and, two, an unfortunate result of what amounts to an unwieldy system that is ‘closed’ – folded in on itself and therefore not ‘open’ to intelligent, intuitive use.

We’ve changed all that by adopting a model inspired by ‘open source’ philosophies. Our applications and platforms are customizable and configurable at every turn. Our users can craft their own custom applications, or transform our existing suite, a roster which is itself being continually expanded by our dedicated (and medically inclined) developers. Ultimately, we’re open about what we have to offer, open to suggestion, and open our doors development on behalf of our users.

This openness extends to the profound interoperability of PuttyHealth™. That is, our EMR has the ability to communicate with other systems using internationally-recognized standards. Yet there is no obligation for EMR vendors to adhere, and it appears this opportunity for negligence has been seized upon by NSW’s current vendor and the result is a substandard product. We’ve always been committed to interoperability and believe it is completely counterintuitive to work against accepted standards if we are to promote connectivity in healthcare.

In “Revised Conclusions of Assessment of FirstNet” (alternatively titled “Is FirstNet an Irredeemable System?”), an addendum containing blackly humorous reports from frazzled doctor-informants trying to work against their malfunctioning EMR, Patrick suggests Australia emulate the UK in their move to a more rigorous, dependable model for national e-health. Rather than a rollout en masse that risks leaving the less tech-savvy behind, or indeed disappointing the advance guard of early adopters, Patrick suggests first that “local hospital networks be given the option to procure and manage their own computing services with a view to further developing a stronger culture of innovation and knowledge sharing between clinical practitioners.” He adds that HSS should shift “purchasing policy to provide for the acquisition of technologies that are provided by specialist suppliers that bring the advanced best of breed technologies into the health workplace, following the lead recently announced by the UK government.”

As newcomers, we can’t help but be excited about these suggestions. We believe that the world of EMR is plagued by a monolithic culture that, perhaps (but perhaps not) inadvertently, emphasizes stasis over flexibility, opacity over transparency, entrenchment rather than innovation. As one of the new – and we hope best – breed of EMR vendors we welcome the melting of the glaciers, so to speak, to enable healthcare providers seeking the best fit to find a space for us.

Finally, and in a sense to recapitulate what we’ve just said, we are mightily pleased, as a small fish in a very large (read corporate and cumbersome) EMR vendor pond, to hear Patrick recommend that HSS “support innovation in the Australian medical software communities that contribute to a culture of innovation and continuous quality improvement.” Music to our ears. We are all that.